Endoscopic Surgical Management of Calcified Thoracic Disc Herniation: A Systematic Review and Meta-Analysis

Calcified thoracic disc herniation (CTDH) is among the most technically demanding conditions in spinal surgery, frequently causing progressive myelopathy and significant spinal cord compression. Traditional open surgical approaches carry substantial perioperative morbidity. The role of endoscopic surgery in this setting remains poorly characterized. This systematic review and meta-analysis aimed to evaluate the safety, clinical efficacy, perioperative efficiency, and complication profile of endoscopic surgical treatment for CTDH. A systematic search of PubMed/MEDLINE, Embase, Scopus, and Web of Science was performed from database inception through April 2026, in accordance with PRISMA 2020 guidelines. Studies reporting endoscopic surgery for radiologically confirmed CTDH and reporting at least one clinical, radiological, or perioperative outcome were eligible. Methodological quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS). Meta-analysis was performed using random-effects models for outcomes reported by three or more studies. Seven studies comprising 57 patients reporting a posterior endoscopic approach for CTDH were included. All studies were retrospective case series of moderate methodological quality (MINORS scores 9–12). Pooled meta-analysis demonstrated significant improvement in axial pain (mean difference [MD]: 3.85, 95% confidence interval [CI]: 2.03–5.67; p < 0.001; I 2 = 70.3%) and neurological function assessed by the modified Japanese Orthopaedic Association score (MD: –2.01, 95% CI: –2.83 to –1.18; p < 0.001; I 2 = 0%). Reported clinical success rates ranged from 90 to 100%. No permanent neurological deterioration or procedure-related mortality was recorded. Mean operative time ranged from 80.6 to 141.7 minutes, estimated blood loss from 11.7 to 140 mL, and hospital length of stay from 1.4 to 5.7 days. Endoscopic surgery appears to be a safe and effective treatment option for selected patients with CTDH, with consistent improvement in pain and neurological function and a favorable perioperative profile. Multiple technical approaches have been described, each suited to specific spinal levels and disc configurations, and approach selection should be guided by lesion anatomy and surgeon expertise rather than treated as a single interchangeable technique. Prospective multicenter studies and randomized trials are required to establish definitive comparative evidence and optimal patient selection criteria.